This week, our guest is one of the country’s leading experts on schizophrenia, Dr. Jeffrey Lieberman. He teaches at the Vagelos College of Physicians and Surgeons, part of Columbia University, where he studies the treatment of mental illness. His research led to the therapeutic strategy of early detection and intervention for a malady of the mind, schizophrenia.
Names for schizophrenia and explanations for why it occurs have changed over the centuries. But we can trace this mysterious mental illness back through human history. For most of that time, those suffering have been stigmatized, isolated and mistreated. Now, though, we have the possibility of effective treatment that could greatly change people’s lives.
According to Dr. Lieberman, schizophrenia has afflicted a similar proportion of the population in different countries and cultures for a long time. Now, however, rates in the US are beginning to rise. He suspects that widespread access to cannabis, ketamine and psychedelic drugs like psilocybin might be pushing vulnerable adolescents over the edge.
This mental illness is characterized by delusions and disorganization in thought patterns, failure of logic in the train of thought and sometimes hallucinations–hearing or seeing things that others do not perceive. If a person suffers repeated bouts of these mental breakdowns, they may end up with impaired mental capacity due to the harm done their brains.
The polygenic brain disorder we call schizophrenia rarely appears before puberty. It is most likely to show up in adolescents and young adults, which can interfere with a timely diagnosis of this malady of the mind. Many youngsters may struggle around this time, while they are striving to establish their individual identities. They may not be living at home; as a result, parents might have a hard time noticing clues that a young person’s brain is going awry.
Without early diagnosis, however, a person cannot get prompt treatment. Starting effective treatment in a timely fashion and getting adequate social support is critical for the individual’s chance of recovery. While once the prognosis was thought to be bleak, we now have evidence that early, coordinated treatment can be very effective and protect the brain from harm.
If you have ever heard of Dorothea Dix, you know that this country once had sizable facilities dedicated to treating people with mental illness. In 1955, these housed some 550,000 individuals. In the 1960s and 1970s, however, most of these institutions were phased out. The motivation was doubtless, in part, to put an end to abuses like those depicted in the novel, One Flew Over the Cuckoo’s Nest. For this move to have served people with a malady of the mind, though, we would have needed to establish outpatient treatment facilities and psychosocial support. For the most part, these are inadequate. Consequently, too many people with mental illness including schizophrenia may end up homeless or in some kind of trouble.
Politicians frequently respond to a violent act such as a mass shooting by blaming mental illness. Without more comprehensive care for those with schizophrenia, however, it is nearly impossible to determine who might be on the verge of a violent act so that it could be prevented.
There are a number of medications that doctors prescribe for people with schizophrenia. Most work on dopamine receptors; the most obvious differences among them relate to their side effect profiles. One antipsychotic drug, clozapine, is more effective than the others. Because it may occasionally cause a blood disorder, however, it is underutilized.
There are three essential components for effective treatment. First, the patient needs an effective medication. But that is only the start. In addition, people with schizophrenia need psychosocial services to help them put their lives back together. Third, and possibly most important, they need the consistent support of a significant other.
As a society, we need to take this malady of the mind seriously. Early detection and appropriate treatment can change the course of a person’s life. Beyond that, we need to provide residential services that offer people with schizophrenia safe places to recover from their delusions.
Jeffrey Lieberman, MD, is Professor and Constance and Stephen Lieber Chair in Psychiatry at Columbia University, Vagelos College of Physicians and Surgeons. Dr. Lieberman's research has advanced the treatment of mental illness and led to the groundbreaking therapeutic strategy of early detection and intervention to prevent the onset of schizophrenia. While on the faculty of the University of North Carolina at Chapel Hill, he led the CATIE Study the largest study ever funded by the United States National Institute of Mental Health comparing the effectiveness of drug treatments for schizophrenia.
His research is published in over 800 scientific articles and 20 books including the critically acclaimed Shrinks: The Untold Story of Psychiatry and MALADY OF THE MIND: Schizophrenia & the Path to Prevention.[caption id="attachment_129405" align="alignnone" width="300"] Jeffrey Lieberman, MD[/caption]